20191420 Ver 1_Shoreline Stabilization_20191014

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State ofNorth Carolina
Department of Environment and NaturalResources
Division ofWater Resources
Water Resources 15ANCACD2M.QS0D—VVaterQuality Certification, Shoreline Stabilization
ENVIRONMENTAL QUALITY FORM: SSGP02'201J
Three copiesmKthe application (including attachments) and the application fee should basent to:
If sending via USPostal Service If sending via delivery service (UPS, Fecft, etc.)
Karen Higgins Karen Higgins
DVVR-4O1/&Buffer Permitting Branch DVVR-4O1&Buffer Permitting
1617 Mail Service Center 512 N.Salisbury Street
Raleigh, NC27839-1617 Raleigh, NC37604
A. Applicant Information [ ] �m
1. Owner Information
Name:
Mailing Address
Telephone Number:
E-mail Address:
2. Agent/ Contact Person information
Fax Number-
1
Asigned anddatedcopyoftheAgentAuthorbation letter must beattached ifthe Agent has
signed this application form. (A form can be downloaded here:
htto://www.saw.usacearmv.mi|/Purta|s/59/docs/rexu|atom/re2docs/Permits/SAMPLE AGENT AUTHOR|Z
Name:
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
B. Project information
1. Attach a vicinity map (i.e. street map) clearly showing the location of the property with
respect tolocal landmarks such as towns, rivers, and roads.
2. Provide a detailed site plan showing property boundaries and proposed locations of
vegetation clearing, buildings, retaining walls, docks impervious surfaces, rip rap, excavation
or dredging below Full Pond/Nonna| Water Level elevations, and construction access
corridors. You may use the diagram provided a1the end ofthis application form.

3. Attach a photograph of the shoreline/ buffer proposed to be stabilized. (Include a scale of
some sort- a yard stick, shovel handle, etc.)
4. Location of the property (where work is to be conducted)
County: _freA2 Nearest Town: N1corP vi l�
Lake/ river/ ocean adjacent to property: yV0r-n(\(V\
Property size (acres):
Subdivision name or site address (include phase/lot number):
176 P©r•A-ro sot Lir-c I lvlovresvl f fe , /L C ( 17
Directions to site - please include road names and numbers, landmarks, etc.: No/die
0A -77 onn ChL,, A-E-e -taKe Ck4 37 -fvrt\ L, iSMlles Lon %.-Jerc;50. CA, --
Latitude (in decimal degrees) _7� ��07 Longitude (decimal degrees) 90. 8C9317 176
S. Describe the existing land use or condition of the site at the time of this application C'm
(residential, undeveloped, etc.): RPsJc-rL+ict I
6. Describe proposed work (include discussion as to how hardening of shoreline has been
SPEtW' ��I
avoided, or why it is necessary): R fm(o,,dnh EkKC na l Slc����15 SLtorPlinP -tv �n
r f kc,ni rif GVf JUS4~ 1, oue d I✓1 41,\$,
7. Will work be conducted from land? HI From water? ❑
8. Total amount of impacts below the normal pool lake level / Normal Water Level
Permanent impacts (including all excavation, backfill, rip rap, retaining walls, etc.) in square feet:
3 15 Q1= 5q;, urp -Ce-(a
Temporary impacts in square feet:
Squt�r -FQ2
9. Total amount of impacts above the normal pool lake level / Normal Water Level and 50 feet
land -ward
nent impacts (including back fill, excavation, rip rap, retaining walls, etc.) in square feet:
i Temporary impacts (temporary clearing, construction corridor) in square feet:
l � 0 0 &11(arP -�ee+-
10. Please describe the vegetation above the normal pool lake level/ Normal Water Level and 50
feet landward to be impacted (number of trees, for instance): 5,-Ca 55 -b
ffx ( 4-1 n!� V)C4 ((, c� g tree C f ui S 1 P �70_ 're C-1
11. Signature
4iA:tz 9 A?
Owner/Agent's Signature` [15A NCAC 02H .0502(f)] Date
*Agent's signature is valid only if an authorization letterfrom the owneris provided.
FORM: SSGP 02-2017 Page 2 of 4

12. Please approximately sketch the following information on this plan and provide dimensions for
each item:
a. All proposed vegetation clearing
b. Location of rip rap orfill to be placed above the Full Pond/ Normal Water Level elevation
c. Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation
d. Location of any proposed structures such as buildings, retaining walls, docks, etc.
e. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
Lake
JAt Full Pond/ Normal Water Level)
CAt\v-
Full Pond/ Normal Water Level
Shoreline
� e
Plan View
Lake
(At Full Pond/ Normal Water Level)
Existing Dock
30 ft. 7R
rrrrrrrrrrrrrr+
�'rrrr+i
FORM: SSGP 02-2017 Page 3 of 4

Lake
(At full Pond/ Normal Water Level)
Side View
L
_ 0l
c
4
a_
FORM: SSGP 02-2017 Page 4 of 4

Goggle Maps 176 Ponderosa Cir
Map data 02019 200 ft

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